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International Urogynecology Journal

, Volume 26, Issue 10, pp 1483–1488 | Cite as

Factors associated with fecal incontinence in a nationally representative sample of diabetic women

  • Maria De La Luz NietoEmail author
  • Jennifer M. Wu
  • Catherine Matthews
  • William E. Whitehead
  • Alayne D. Markland
Original Article

Abstract

Introduction and hypothesis

Fecal incontinence (FI) is a debilitating condition that significantly affects quality of life, and has been associated with multiple risk factors. Our goal was to assess the prevalence of FI among diabetic women and evaluate factors associated with FI in this population.

Methods

The National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 was used to evaluate women with diabetes mellitus and FI. FI was defined as involuntary loss of mucus, liquid, or solid stool at least monthly. Severity was evaluated using the Fecal Incontinence Severity Index. Potential risk factors associated with FI were explored with weighted chi-squared statistics. Variables associated with FI in multivariable logistic regression analysis are reported with odds ratios (OR) and 95 % confidence intervals (95 % CI).

Results

Among 7,039 women, 13.6 % were diabetic, and 18.1 % of diabetic women reported FI compared to 8.4 % in the overall NHANES population (p < .001). In diabetic women, FI was associated with advancing age (OR 1.3, 95 % CI 1.1 – 1.5), depression (OR 2.0 95 % CI 0.9 – 4.5), poorer health status (OR 1.9, 95 % CI 1.2 – 3.1), urinary incontinence (OR 3.5, 95 % CI 2.1 – 5.9) and bowel movement frequency of ≥21/week (OR 4.9, 95 % CI 2.3 – 10.6) in a multivariable logistic regression model adjusted for race, education level, BMI, comorbidities, prior hysterectomy, and stool consistency.

Conclusions

FI affects one in five diabetic women and is strongly associated with high bowel movement frequency, a possible important modifiable factor that should be investigated further in prospective studies.

Keywords

Diabetes Fecal incontinence Urinary incontinence Health status 

Notes

Conflicts of Interest

J.M. Wu: Proctor and Gamble Consultant

C. Matthews: Pelvalon and Boston Scientific Consultant

W.E. Whitehead: Salix Pharmaceuticals, Taxeda Pharmaceuticals, Rome Pharmaceuticals Consultant

References

  1. 1.
    Crowell M, Schettler VA, Lacy B et al (2007) Impact of anal incontinence on psychosocial function and health-related quality of life. Dig Dis Sci 52(7):1627–1631CrossRefPubMedGoogle Scholar
  2. 2.
    Handa VL, Zyczynski HM, Burgio KL et al (2007) The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. Am J Obstet Gynecol 197(6):e1–e6CrossRefGoogle Scholar
  3. 3.
    Dunivan GC, Heymen S, Palsson OS et al (2010) Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 202(5):493.e491–493.e496Google Scholar
  4. 4.
    Whitehead WE, Borrud L, Goode PS et al (2009) Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 137(2):512–517, 517.e1–517.e2PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Ditah I, Devaki P, Luma HN et al (2014) Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterol Hepatol 12(4):636–643CrossRefPubMedGoogle Scholar
  6. 6.
    Matthews CA, Whitehead WE, Townsend MK, Grodstein F (2013) Risk factors for urinary, fecal, or dual incontinence in the Nurses’ Health Study. Obstet Gynecol 122(3):539–545PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention (2011) National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. US Department of Health and Human Services, AtlantaGoogle Scholar
  8. 8.
    Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF (2010) Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr 8:29.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Gregg EW, Boyle JP, Thompson TJ, Barker LE, Albright AL, Williamson DF (2013) Modeling the impact of prevention policies on future diabetes prevalence in the United States: 2010–2030. Popul Health Metr 11(1):18PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Johnson CL, Paulose-Ram R, Ogden CL et al (2013) National health and nutrition examination survey: analytic guidelines, 1999–2010. Vital Health Stat 2(161):1–24Google Scholar
  11. 11.
    Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532CrossRefPubMedGoogle Scholar
  12. 12.
    Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32(9):920–924CrossRefPubMedGoogle Scholar
  13. 13.
    Sandvik H, Espuna M, Hunskaar S (2006) Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J Pelvic Floor Dysfunct 17(5):520–524CrossRefPubMedGoogle Scholar
  14. 14.
    Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B (2007) Patterns of prevalent major chronic disease among older adults in the United States. JAMA 298(10):1160–1162CrossRefPubMedGoogle Scholar
  15. 15.
    Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Brown HW, Wexner SD, Segall MM, Brezoczky KL, Lukacz ES (2012) Quality of life impact in women with accidental bowel leakage. Int J Clin Pract 66(11):1109–1116CrossRefPubMedGoogle Scholar
  17. 17.
    Burgio KL, Borello-France D, Richter HE et al (2007) Risk factors for fecal and urinary incontinence after childbirth: the Childbirth and Pelvic Symptoms Study. Am J Gastroenterol 102(9):1998–2004CrossRefPubMedGoogle Scholar
  18. 18.
    Scarpello JH, Hodgson E, Howlett HC (1998) Effect of metformin on bile salt circulation and intestinal motility in type 2 diabetes mellitus. Diabet Med 15(8):651–656CrossRefPubMedGoogle Scholar
  19. 19.
    Malloy J, Meloni A, Han J (2013) Efficacy and tolerability of exenatide once weekly versus sitagliptin in patients with type 2 diabetes mellitus: a retrospective analysis of pooled clinical trial data. Postgrad Med 125(3):58–67CrossRefPubMedGoogle Scholar
  20. 20.
    Halland M, Koloski NA, Jones M et al (2013) Prevalence correlates and impact of fecal incontinence among older women. Dis Colon Rectum 56(9):1080–1086CrossRefPubMedGoogle Scholar
  21. 21.
    Rortveit G (2010) Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort: prevalence and risk factors. Female Pelvic Med Reconstr Surg 16(5):278–283CrossRefPubMedGoogle Scholar
  22. 22.
    Townsend MK, Matthews CA, Whitehead WE, Grodstein F (2013) Risk factors for fecal incontinence in older women. Am J Gastroenterol 108(1):113–119PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Iantorno M, Campia U, Di Daniele N et al (2014) Gut hormones and endothelial dysfunction in patients with obesity and diabetes. Int J Immunopathol Pharmacol 27(3):433–436PubMedGoogle Scholar
  24. 24.
    Bagger JI, Christensen M, Knop FK, Tb V (2011) Therapy for obesity based on gastrointestinal hormones. Rev Diabet Stud 8(3):339–347PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Wyndaele M, De Winter BY, Pelckmans PA, De Wachter S et al (2014) Exploring associations between lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems in women: a study in women with urological and GI problems vs a control population. BJU Int. doi: 10.1111/bju.12904
  26. 26.
    Botlero R, Bell RJ, Urquhart DM, Davis SR (2011) Prevalence of fecal incontinence and its relationship with urinary incontinence in women living in the community. Menopause 18(6):685–689CrossRefPubMedGoogle Scholar
  27. 27.
    Napolitano A, Miller S, Nicholls AW et al (2014) Novel gut-based pharmacology of metformin in patients with type 2 diabetes mellitus. PLoS One 9(7), e100778PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Maty SC, Fried LP, Volpato S, Williamson J, Brancati FL, Blaum CS (2004) Patterns of disability related to diabetes mellitus in older women. J Gerontol A Biol Sci Med Sci 59(2):148–153CrossRefPubMedGoogle Scholar
  29. 29.
    Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik JM (2002) Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women’s Health and Aging Study. Diabetes Care 25(4):678–683CrossRefPubMedGoogle Scholar
  30. 30.
    Wu JM, Vaughan CP, Goode PS et al (2014) Prevalence and trends of symptomatic pelvic floor disorders in U.S. Women. Obstet Gynecol 123(1):141–148PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Maria De La Luz Nieto
    • 1
    Email author
  • Jennifer M. Wu
    • 1
    • 2
  • Catherine Matthews
    • 1
  • William E. Whitehead
    • 3
  • Alayne D. Markland
    • 4
    • 5
  1. 1.Division of Urogynecology, Department of Ob/GynUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Center for Women’s Health Research, Center for Aging and HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Birmingham VAMC GRECCBirminghamUSA
  5. 5.Department of Medicine, Division of Gerontology, Geriatrics, and Palliative CareThe University of Alabama at BirminghamBirminghamUSA

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